Women's Adjustment Research Articles

Women's adjustment trajectories during IVF and impact on mental health 11-17 years later.

Do patients present different adjustment trajectories during and after IVF treatment? Most women show resilient trajectories during and after IVF treatment but 37% show temporary or chronic maladjustment during IVF and 10% are maladjusted 11-17 years after treatment. Research on patient psychosocial adjustment during treatment has contributed to identifying the most distressful stages of IVF treatment and profiling patients at risk for emotional maladjustment at these specific stages. This knowledge is currently driving the deliverance of psychosocial care at fertility clinics by tailoring it to patients' risk profiles and specific treatment stages. However, current care does not take into consideration how individuals adjust across the entire treatment pathway. This can be assessed by profiling individual adjustment trajectories. A longitudinal cohort study with five assessment moments that combines data from two different studies, the STRESSIVF and OMEGA projects. Participants enrolled in the STRESSIVF study (started IVF in 1998-2000) were assessed before and after the first IVF treatment cycle and 6 months and 2.5 years after the last IVF cycle. A subset participated in the OMEGA project (started IVF in 1995-2000) and reported on their mental health 11-17 years after treatment. Three hundred and forty-eight women participated in the STRESSIVF project and 108 of these in the OMEGA. Anxiety was measured with the State and Trait Anxiety Inventory, depression with the Beck Depression Inventory and mental health with the Mental Health Inventory. Latent class growth mixed modelling was carried out to identify distinct anxiety and depression trajectories over the four STRESSIVF study assessment moments. Multinominal logistic regressions were conducted to investigate predictors of trajectory membership, and stepwise linear regressions were performed to investigate if adjustment trajectories predicted mental health 11-17 years after IVF treatment. A total of 67 and 86% of women showed normal levels of anxiety and depression, respectively, throughout treatment (resilient trajectories), 24 and 33% experienced anxiety and depression only during treatment (recovery trajectories), 4.6 and 4.9% experienced anxiety and depression only after treatment (delayed trajectories), and 4.3% showed chronic anxiety (chronic trajectory, not identified for depression). Non-resilient trajectories were associated with unsuccessful treatment, marital dissatisfaction, lack of social support and negative infertility cognitions. One in 10 women had a delayed or chronic trajectory and these trajectories predicted serious mental health impairment 11-17 years after treatment. The study only focuses on women. In the OMEGA project adjustment was assessed using a mental health measure. Although we could investigate how trajectories predicted mental health, it would have been preferable to map anxiety and depression trajectories up to 11-17 years after treatment. Missing analysis showed selective dropout from the study but this was accounted for by using mixed models and imputation procedures. Finally, data on other life stressors were not collected; therefore any contribution from these events cannot be assessed. Fertility health-care providers have been called upon considering their responsibility in supporting patients in the aftermath of treatment. Results show it is possible to profile different groups of at-risk women at the start of the treatment and tailor psychosocial support to risk profile to promote health adjustment during treatment and thereafter. This study was supported by a grant from the Dutch Cancer Society (2006-3631) and the Praeventiefonds (28-3012). No competing interests exist.

Psychological Treatments for Provoked Vestibulodynia: Integration of Mindfulness-Based and Cognitive Behavioral Therapies.

Provoked vestibulodynia (PVD) is a chronic and distressing genital pain condition involving sharp pain to the vulvar vestibule with lifetime prevalence as high as 12%. PVD is the most prevalent cause of pain during sexual intercourse (dyspareunia) in premenopausal women, and gives rise to considerable sexual and relational concerns. As intercourse for women with PVD is either painful or impossible, PVD has pronounced negative effects on women's romantic relationship adjustment and sexual intimacy, as well as their emotional well-being and sense of sexual self-efficacy. Given the low efficacy and high side-effect profile of medications for the treatment of PVD, attention has shifted toward psychological interventions over the past decade. Psychological treatments for PVD have the advantage of targeting both the experience of pain and its many psychosexual consequences, such as reduced desire and arousal. Cognitive behavioral therapy (CBT) currently represents one of the most popular first-line psychological interventions for PVD. Mindfulness has been increasingly used alongside, or instead of CBT for a variety of health-related conditions, particularly with respect to chronic pain disorders and more recently in women with PVD. This review provides a detailed overview of CBT and mindfulness-based approaches in treating PVD.

Sexual Assault in Bisexual and Heterosexual Women Survivors

ABSTRACTIn cross-sectional studies, social support is related to sexual minority status and negative psychological impact among sexual assault survivors. However, longitudinal studies of this relationship are few or non-existent. Using a prospective design, the authors compared bisexual and heterosexual survivors on how different types of social support are connected to symptoms of post-traumatic stress disorder (PTSD) and depression. A community sample of bisexual and heterosexual (N = 905) women sexual assault survivors completed three annual surveys. Heterosexual women reported greater perceived social support and fewer negative reactions to disclosure of sexual assault than bisexual women, but there were no differences in frequency of social contact. Perceived social support and frequency of social contact were related to fewer psychological symptoms of PTSD and depression for all women. Heterosexual women had fewer psychological symptoms than bisexual women. Finally, perceived social support mediated the relationship of sexual orientation with depressive symptoms but not with PTSD symptoms. These findings suggest that social support and sexual orientation may explain women's post-assault adjustment.

Associations Between Penetration Cognitions, Genital Pain, and Sexual Well-being in Women with Provoked Vestibulodynia.

Provoked vestibulodynia (PVD) is a common vulvovaginal pain condition that negatively impacts women's psychological and sexual well-being. Controlled studies have found that women with PVD report greater negative and less positive cognitions about penetration; however, associations between these types of cognitions and women's pain and sexual well-being remain unknown. Further, researchers have yet to examine how interpersonal variables such as sexual communication may impact the association between women's penetration cognitions and PVD outcomes. We examined associations between vaginal penetration cognitions and sexual satisfaction, sexual function, and pain in women with PVD, as well as the moderating role of sexual communication. Seventy-seven women (M age= 28.32, SD= 6.19) diagnosed with PVD completed the catastrophic and pain cognitions and positive cognitions subscales of the Vaginal Penetration Cognition Questionnaire, as well as the Dyadic Sexual Communication Scale. Participants also completed measures of sexual satisfaction, sexual function, and pain. Dependent measures were the (i) Global Measure of Sexual Satisfaction Scale; (ii)Female Sexual Function Index; and (iii) Present Pain Intensity scale of the McGill Pain Questionnaire, with reference to pain during vaginal intercourse. Women's lower catastrophic and pain cognitions, higher positive cognitions, and higher sexual communication were each uniquely associated with higher sexual satisfaction and sexual function. Lower catastrophic and pain cognitions also were associated with women's lower pain. For women who reported higher sexual communication, as positive cognitions increased, there was a significantly greater decrease inpain intensity during intercourse compared to women who reported lower levels of sexual communication. Findings may inform cognitive-behavioral interventions aimed at improving the pain and sexual well-being of women with PVD. Targeting the couple's sexual communication and women's penetration cognitions may improve women's sexual adjustment and reduce pain.

What's your motivation to be pregnant? Relations between motives for parenthood and women's prenatal functioning.

Prenatal psychological adjustment is a critical predictor of postnatal maternal adjustment, which, in turn, relates to a child's psychological development. As such, it is important to examine possible correlates of women's psychological functioning during pregnancy. Grounded in self-determination theory (Deci & Ryan, 2000), the present research investigated the link between women's motives for having a child and prenatal maternal psychological adjustment. Specifically, in a sample of 208 pregnant women, we examined the relation between women's intensity (i.e., quantity) and quality of motivation for having a child and both women's social adjustment (i.e., relationship satisfaction) and personal well-being (i.e., vitality and depressive symptoms). Further, we examined psychological need satisfaction as an explanatory mechanism underlying these associations. Results showed that both intensity and quality of motivation related, either directly or indirectly via psychological need satisfaction, to women's personal well-being and relationship satisfaction during pregnancy.

British-Pakistani women's perspectives of diabetes self-management: the role of identity.

To explore the effects of type 2 diabetes on British-Pakistani women's identity and its relationship with self-management. Type 2 diabetes is more prevalent and has worse outcomes among some ethnic minority groups. This may be due to poorer self-management and an inadequate match of health services to patient needs. The influence that type 2 diabetes has on British-Pakistani women's identity and subsequent self-management has received limited attention. An explorative qualitative study. Face-to-face semi-structured English and Urdu language interviews were conducted with a purposively selected heterogeneous sample of 15 British-Pakistani women with type 2 diabetes. Transcripts were analysed thematically. Four themes emerged: Perceived change in self emphasised how British-Pakistani women underwent a conscious adaptation of identity following diagnosis; Familiarity with ill health reflected women's adjustment to their changed identity over time; Diagnosis improves social support enabled women to accept changes within themselves and Supporting family is a barrier to self-management demonstrated how family roles were an aspect of women's identities that was resilient to change. The over-arching theme Role re-alignment enables successful self-management encapsulated how self-management was a continuous process where achievements needed to be sustained. Inter-generational differences were also noted: first generation women talked about challenges associated with ageing and co-morbidities; second generation women talked about familial and work roles competing with self-management. The complex nature of British-Pakistani women's self-identification requires consideration when planning and delivering healthcare. Culturally competent practice should recognise how generational status influences self-identity and diabetes self-management in ethnically diverse women. Health professionals should remain mindful of effective self-management occurring alongside, and being influenced by, other aspects of life.

Psychosocial Adjustment in Women with Schizophrenia using the Tamil Version of B-WISE

Obesity due to antipsychotic induced weight gain is a significant problem in patients with schizophrenia. An instrument to evaluate body image and self-esteem (B-WISE) related to weight has recently been developed. To evaluate psychosocial adjustment based on body image and self esteem using B-WISE in Schizophrenia. In a cross-sectional case control design, 82 female patients attending Schizophrenia Research Foundation services were recruited. The translated Tamil version of the B-WISE was administered by two raters independently within a 3 week interval to establish test–retest reliability. Scores on B-WISE categories differed significantly between cases and controls (p = 0.034) but majority reported good psychosocial adjustment. Test restest reliability of the tamil version of the B-WISE was found to be good with kappa value 0.78. B-WISE could be a useful screening instrument to evaluate the psychosocial consequences associated with weight gain in patients with schizophrenia.

Partner support and anxiety in young women with breast cancer.

Using a large prospective cohort of women age 40 or younger diagnosed with breast cancer, we examined the relationship between perceived partner support and anxiety. Six hundred seventy-five young women with breast cancer Stages I-III, median age 36, completed a self-report baseline questionnaire. Perceived partner support was assessed using items extracted from the marital subscale of the Cancer Rehabilitation Evaluation System; generalized social support was assessed with the Medical Outcomes Study-Social Support Survey. Anxiety was measured using the anxiety subscale of the Hospital Anxiety and Depression Scale. Multivariable logistic regression analyses evaluated the association between partner support, other sociodemographic factors, and anxiety. Mean age at diagnosis was 35.4 years. Fourteen percent of the women were not partnered, and among those who were partnered or in a significant relationship, 20% were categorized as unsupported. In univariate and multivariable analysis adjusting for sociodemographic factors, women in an unsupported-partnered relationship had higher odds of anxiety symptoms compared with women in a supported-partnered relationship. Young age and being financially insecure were also both independently associated with anxiety. Our findings suggest that partner support may play a key role in a young woman's adjustment to a serious stressor such as breast cancer. In addition, younger age increases vulnerability to anxiety as does struggling with finances. Because supportive efforts of a partner have potential to protect against the impact of stress, interventions to enhance partner support and reduce anxiety might be beneficial to address challenges experienced as a couple in this setting.

Sexual satisfaction, sexual compatibility, and relationship adjustment in couples: the role of sexual behaviors, orgasm, and men's discernment of women's intercourse orgasm.

Research indicated that (i) vaginal orgasm consistency is associated with indices of psychological, intimate relationship, and physiological functioning, and (ii) masturbation is adversely associated with some such measures. The aim of this study was to examine the association of various dyadic and masturbation behavior frequencies and percentage of female orgasms during these activities with: (i) measures of dyadic adjustment; (ii) sexual satisfaction; and (iii) compatibility perceived by both partners. In a sample of 85 Czech long-term couples (aged 20-40; mean relationship length 5.4 years), both partners provided details of recent sexual behaviors and completed sexual satisfaction, Spanier dyadic adjustment, and Hurlbert sexual compatibility measures. Multiple regression analyses were used. The association of sexual behaviors with dyadic adjustment, sexual compatibility, and satisfaction was analyzed. In multivariate analyses, women's dyadic adjustment is independently predicted by greater vaginal orgasm consistency and lower frequency of women's masturbation. For both sexes, sexual compatibility was independently predicted by higher frequency of penile-vaginal intercourse and greater vaginal orgasm consistency. Women's sexual satisfaction score was significantly predicted by greater vaginal orgasm consistency, frequency of partner genital stimulation, and negatively with masturbation. Men's sexual satisfaction score was significantly predicted by greater intercourse frequency and any vaginal orgasm of their female partners. Concordance of partner vaginal orgasm consistency estimates was associated with greater dyadic adjustment. The findings suggest that specifically penile-vaginal intercourse frequency and vaginal orgasm consistency are associated with indices of greater intimate relationship adjustment, satisfaction, and compatibility of both partners, and that women's masturbation is independently inversely associated with measures of dyadic and personal function. Results are discussed in light of previous research and an evolutionary theory of vaginal orgasm.

A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners.

The diagnosis and treatment of prostate cancer is followed by substantive sexual morbidity. The optimal approach for intervening remains unclear. A three-arm randomised control trial was undertaken with 189 heterosexual couples where the man had been diagnosed with prostate cancer and treated surgically. The efficacy of peer-delivered telephone support versus nurse-delivered telephone counselling versus usual care in improving both men's and women's sexual adjustment was investigated. Assessments were undertaken at baseline (pre-test) with follow-up at 3, 6 and 12 months. At 12 months, men in the peer (p = 0.016) and nurse intervention (p = 0.008) were more likely to use medical treatments for erectile dysfunction (ED) than men in the usual care arm. Men in the nurse intervention more frequently used oral medication for ED than men in usual care (p = 0.002). No significant effects were found for sexual function, sexuality needs, sexual self-confidence, masculine self-esteem, marital satisfaction or intimacy. Although peer and nurse couples-based interventions can increase use of medical treatments for ED, this may not translate into better sexual or relationship outcomes. More research is needed into the optimal timing of interventions to improve sexual outcomes for men with prostate cancer and to identify the subpopulations that will benefit from them.

Abstract A32: Impact of Nueva Vida's model on disparate levels of quality of life, distress, and self-efficacy in Latinas with breast cancer

Abstract Breast cancer is the most common cancer diagnosis among Latinas, and Hispanic women diagnosed with breast cancer have a higher mortality rate than their white non-Hispanic counterparts. Moreover, Latina survivors appear to have greater distress related to their diagnosis and treatment than non-Latina white women, in large part due to their lower access to care, financial and linguistic barriers, and cultural issues. These concerns have significant influence on women's quality of life (QOL), yet research indicates their impact may be buffered by the presence of mental health and social support services. Research conducted with predominantly non-Latina survivors suggests that social support positively influences women's adjustment to breast cancer by reducing the intensity of their psychological distress, enhancing their optimism and QOL and encouraging treatment adherence. There is, however, an acknowledged gap in the availability of adequate support interventions for minority groups. Nueva Vida is a community-based organization that provides comprehensive psychosocial support to Latinas with cancer in the Washington, DC, area. Purpose: The goal of this community-based participatory research (CBPR) project is to evaluate the impact of Nueva Vida's model on levels of self-efficacy, psychological distress, and quality of life. The NV model provides a variety of services that include patient navigation, support groups, individual counseling, peer support, and resources and information. This study looked at the impact of this model for one year. Procedures: This study is a time-series design with Time 1 (T1) data collection on the day of initial contact with NV, time 2 (T2) within 3 - 10 days of initial contact, time 3 (T3) at 4 months, and time 4 (T4) at 12 months. The instruments used in this study include: Cancer Behavior Inventory - Version 2.0 (CBI) measuring self-efficacy, the Brief Symptom Inventory-18 (BSI-18) measuring psychological distress, and the Satisfaction with Life Domains Scale- Breast Cancer (SLDS-BC) measuring QOL. The sample included 92 Latina women diagnosed with breast cancer that contacted NV and agreed to participate in the study. The interventions offered over the course of the twelve months include, individual counseling, various support group participation, patient navigation, and peer support. Unpublished data: Eighty-seven participants completed data at Time 1, 69 at T2, 64 at T4, and 57 at T4. There was a statistically significant decrease in depression from T1 to T4 (t = 2.131, df = 55, p < .05) and distress from T1 to T4 (t = 2.302, df = 55, p < .05). In addition, there were trends toward significant decrease in anxiety scores from T1 to T4 ( t = 1,827, df, 55, p < .10) and somatization from T1 to T4 (t = 1.784, df = 55, p < .10). There was a statistically significant improvement in QOL from T1 to T4 (t = -3.453, 49, p < .01). There was no change found in self-efficacy. Conclusions: The findings support the model that NV uses in improving the lives of Latinas diagnosed with breast cancer, demonstrating that a community-based organization with comprehensive social support services can help reduce distress levels and increase QOL. No change in self-efficacy has brought into question the cultural transferability the instrument selected to measure this variable in this population. Citation Format: Margaret LG Darling, Claudia Campos, Larisa Caicedo, Karlynn BrintzenhofeSzoc, James R. Zabora, Marcela Blinka, Florencia Gonzalez. Impact of Nueva Vida's model on disparate levels of quality of life, distress, and self-efficacy in Latinas with breast cancer. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A32. doi:10.1158/1538-7755.DISP13-A32

Impact of Gender Role Conflict on Adjustment in Women With Traumatic Brain Injury

Impact of Gender Role Conflict on Adjustment in Women With Traumatic Brain Injury

Role of Social Skills in Improving the Women's Marital Adjustment in the City of Sanandaj

This research was done with the aim of studying the role of social skills in improving the women's marital adjustment and its specialized objectives are addressing the role and effect of cognitive, behavioral, and emotional skills, women's age, acquaintance with the husband before marriage, work place of the husband, woman's educational level , their employment, and number of their children on their marital adjustment (dependent variable). The theoretical framework of this study consists of theories of Nay's social exchange, Coffman's dramatic theory, the models of Elizabeth Bath's roles, Godden’s pure relationship, Coleman's social-cognitive capital, Framo's internal conflict solution, Negee's ethical criteria, Guttmann's elimination of conflicts, Buchner's self –disclosure, Ellis's illogical and inflexible thoughts, Mitchell's family life cycle, and Bourdieu's cultural capital. The survey method research was employed in this study and the statistical universe consisted of women aged 20-55 and the sample size of 365 people were selected through the multi stage cluster and random sampling. Research instrument was questionnaires, asking questions related to social skills through researcher made questionnaires and to measure the marital adjustment variable the Lock-Wallace marital adjustment questionnaire was applied. Research findings suggest that there is a significant relationship between variables of social skills (cognitive, behavioral and emotional variables) on one hand, and marital adjustment of the other hand, so that by increasing cognitive behavioral and emotional skills, the degree of marital adjustment will also rise. Also, there is a meaningful relationship among the age difference between husbands and wives, number of their children, education level, and women's profession on one hand and marital adjustment on the other hand. Also, the marital adjustment of women in terms of acquaintance before marriage and the spouse's were place was different, that is the ones who were acquainted with each other and the work place of their spouses were in Sanandaj had higher marital durability.

Pre‐therapy relationship adjustment, gender and the alliance in couple therapy

This study examined gender differences in session one alliances and in the trajectory of the alliance over the course of couple therapy. Additionally, this study examined the association between men and women's pre‐therapy relationship adjustment and alliance at session one and over the course of therapy. A total of 316 couples seeking outpatient couple therapy were given the Locke–Wallace marital adjustment test at pre‐therapy to measure relationship adjustment and the session rating scale after each session to measure alliance with the therapist. The results showed that men had lower alliance ratings after session one than women. Men's pre‐therapy relationship adjustment was positively associated with their own session one alliance as well as their own alliance trajectory over the course of therapy. Men's pre‐therapy relationship adjustment was also positively associated with their partner's session one alliance. Women's pre‐therapy relationship adjustment showed no significant relationship with their own alliance or their partners at session one or the alliance trajectory over the course of therapy. The implications for how these gender differences may impact on the process of couple therapy with heterosexual couples are discussed.Practitioner points Initial alliances may differ for men and women in heterosexual couples and attending to reasons for seeking help may be instrumental. Partners’ pre‐therapy relationship distress can negatively impact on early alliance establishment; thus, more attention to the alliance may be needed for more distressed couples. Therapists may want to monitor the alliances in couple therapy to develop a better understanding of each partner's engagement in the process.

Abstract P6-08-13: Impact of Nueva Vida’s model on quality of life, distress levels and self-efficacy in Latinas with breast cancer

Abstract Breast cancer is the most common cancer diagnosis among Latinas and Hispanic women diagnosed with breast cancer have a higher mortality rate than their white non-Hispanic counterparts (American Cancer Society, 2009). Moreover, Latina survivors appear to have greater distress related to their diagnosis and treatment than non-Latina White women, in large part due to their lower access to care, financial and linguistic barriers, and cultural issues. These concerns have a significant influence on women quality of life (Rowland & Massie, 1998) yet research indicates their impact may be buffered by the presence of mental health and social support services. Research conducted with predominantly non-Latina survivors suggests that social support positively influences women's adjustment to breast cancer by reducing the intensity of their psychological distress, enhancing their optimism and quality of life and encouraging treatment adherence. (e.g. Helgeson & Cohen). There is, however, an acknowledged gap in the availability of adequate support interventions for minority groups (Buki, LP, et al, 2008). Purpose: Breast Cancer is the most common cancer diagnosis among Latina women in the US and Latinas have a higher mortality rate than their white non-Hispanic counterparts (American Cancer Society, 2009). Based on this data and the lived experiences of Latina's with breast cancer, Nueva Vida (NV) was founded in 1996 in efforts to address the lack of culturally sensitive cancer support services for Latinas in the Washington, DC area. NV's comprehensive cancer care service model includes patient navigation, various types of support groups, individual counseling, peer support, and education. This community based organization-academic partnership project evaluated the impact of NVs service model on participants’ levels of self-efficacy, psychological distress, and quality of life. Methods: A time-series design with data collection on the day of initial contact with NV, within 3-10 days of initial contact, as well as 4 and 12 months after the initial contact with NV. Sample includes approximately 90 Latinas diagnosed with breast cancer. Instruments used in this study include: Cancer Behavior Inventory (CBI) version 2 measuring self-efficacy (Merluzzi et al., 2001); the Brief Symptom Inventory-18 (BSI-18) measuring psychological distress (Zabora et al., 2001); and the Satisfaction with Life Domains Scale- Breast Cancer (SLDS-BC) measuring quality of life (Spagnola et al., 2003). Results: Data collection took place between March 2008 and December 2010. Participants seen at NV improved in three of the four categories measured by the BSI-18. The median quality of life scores improved over time. However, the self-efficacy median remained consistent over the year. Conclusions: The negative impact of a cancer diagnosis can be offset by the presence of social support, particularly for Latinas. Similarly, Latinas quality of life can improve with social support. However more studies are needed to understand what types of support services contribute to improvements in quality of life. Further study of self-efficacy based on type and number of interventions is needed. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-13.

Comparing Taiwanese women's biopsychosocial features by location of postpartum recovery

BackgroundIn Taiwan, a culturally sanctioned ritual of maternal rest and recuperation has been traditionally practiced patrilocally during the first postpartum month. However, in recent years, the places where women may observe the ritual have become more diverse. AimOur goal was to compare women's psychosocial features based on where they stayed during their postpartum recovery. MethodsUsing proportional stratified quota sampling of 18 hospitals and clinics in Taiwan by birth rate, we recruited 784 postpartum women. ResultsWomen stayed in their own home (17.1%), with their parents-in-law (33.3%), with their parents (36.0%), or in a postpartum nursing center (13.6%). Women who stayed in their own residence or who stayed in their parents' residence perceived greater social support than women who stayed with their parents-in-law. ConclusionsFurther research should compare women's adjustment to motherhood and their competence in childcare based on where they stay during postpartum recovery.

Changes in PTSD symptomatology and mental health during pregnancy and postpartum.

Changes in mental health symptoms throughout pregnancy and postpartum may impact a woman's experience and adjustment during an important time. However, few studies have investigated these changes throughout the perinatal period, particularly changes in posttraumatic stress disorder (PTSD) symptoms. The purpose of this study was to examine longitudinal changes in PTSD, depression, and anxiety symptomatology during pregnancy and postpartum. Pregnant women of ethnically diverse backgrounds receiving services for prenatal care at an outpatient obstetric-gynecology clinic or private physicians' office were assessed by interview on symptoms of PTSD, depression, anxiety, and general stress up to four times, including their first, second, and third trimester, and postpartum visits. Overall, during pregnancy there was a declining trend of PTSD symptoms. For anxiety, there was no overall significant change over time; however, anxiety symptoms were individually variable in the rate of change. For both depression and general stress symptoms, there was a declining trend, which was also variable in the individual rate of change among women during their pregnancy. Visual and post hoc analyses also suggest a possible peak in PTSD symptoms in the weeks prior to delivery. While most mental health symptoms may generally decrease during pregnancy, given the individual variability among women in the rate of change in symptoms, screening and monitoring of symptom fluctuations throughout the course of pregnancy may be needed. Further studies are needed to examine potential spiking of symptoms in the perinatal period.

An Integrative and Socio-Cultural Perspective of Health, Wealth, and Adjustment in Widowhood

Women comprise a larger proportion of the ageing population than men, often outlive their spouses, and face a variety of challenges upon widowhood. Discrete aspects of the health impact of widowhood have been described in the literature; however, the expanse of sociocontextual issues that impact on older women's adjustment is less prominent. We undertook a literature review to synthesize recent research and interventions and identify current trends and gaps in knowledge and services. Although many health, social, cultural, and economic factors impact on recently widowed older women throughout the world, we found that few interventions targeting this population incorporate these factors.

Executive Functions, Depressive Symptoms, and College Adjustment in Women

Many students have difficulty adjusting to college, and the contribution of academic and relational factors have been considered in previous research. In particular, depression commonly emerges among college women at this time and could be related to poor adjustment to college. This study examined the relationship between executive functions, depressive symptoms, and college adjustment in college women. Seventy-seven female participants from a midsize urban university completed the Wechsler Abbreviated Scale of Intelligence, College Adjustment Scale, Beck Depression Inventory-Second Edition, Behavior Rating Inventory of Executive Function-Adult Version, and four subtests from the Delis-Kaplan Executive Function System: the Trail-Making Test, Design Fluency Test, Verbal Fluency Test, and Color–Word Interference Test. After controlling for IQ score, hierarchical regression analyses showed that subjective and objective measures of executive functioning and depressive symptoms were significantly related to college adjustment problems in academic, relational, and psychological areas. The current study provides evidence for a relationship between cognitive abilities, psychiatric symptoms, and college adjustment.

A retrospective investigation of women’s experience with breast reconstruction after mastectomy

A diagnosis of breast cancer is often accompanied by the fear of loss of previous body image and attractiveness. Hence, many patients opt for reconstructive surgery. This study evaluated the effects of different types of reconstructive surgery after mastectomy on the functional and psychological adjustment of patients. In a cohort study, patients, who had breast reconstruction after mastectomy by means of four different allogenic or autologues techniques between 1999-2006 were retrospectively interviewed in person or by telephone. The questions addressed complication rates, physical complaints, functional impairments, body image outcomes, sexuality and patient satisfaction. Of 139 patients, 89 (64.7 %) completed the survey. 32 (35.9 %) patients experienced one or more postoperative complications like seroma, hematoma, infections or necrosis. 16 (20 %) and 13 (16 %) patients reported strong and moderate adverse effects on sexuality, respectively. 62 (70 %) patients indicated that they were actively included in the decision making process. Patient ratings of good or bad medical advice were associated with complication rates (p = 0.008). Patients, who evaluated their first preoperative counseling positively, reported higher consent rates when a re-reconstruction became necessary (p ≤ 0.001). Satisfaction with the functional outcome after reconstruction and satisfaction with the cosmetic result was highly correlated (p < 0.001). A significant association of patient satisfaction with postoperative complications and the decision for a re-reconstruction was demonstrated. Furthermore, our results emphasize the importance of detailed preoperative counseling for women's adjustment to reconstructive surgery.